| NPI | 1932320967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: TX L5003) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: TX 15919) |
| 2086X0206X Surgery, Surgical Oncology (Licence: TX L5003) | |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2018-03-09 |