| NPI | 1942258397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: GA DN012107) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: SC 3663) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: GA DNGA000189) | |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2021-10-22 |