| NPI | 1982046892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: VA 0438000437) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401415968) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MN S131) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: MN S131) | |
| Enumeration Date | 2013-07-19 |
| Last Update Date | 2024-01-11 |