| NPI | 1972912723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: GA DN123057) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: AL D.007246-C) |
| Enumeration Date | 2014-08-06 |
| Last Update Date | 2024-11-13 |