| NPI | 1982622585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: SC 3550) |
| Additional Taxonomies | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: SC 003550) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2020-03-23 |