| NPI | 1962630087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: AK 108819) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: AK 108546) |
| Enumeration Date | 2009-06-26 |
| Last Update Date | 2019-06-20 |