| NPI | 1982807053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: OH 35.124054) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: OH 35.124054) |
| Enumeration Date | 2007-06-07 |
| Last Update Date | 2021-08-25 |