| NPI | 1982902821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: MI 2901022095) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: MI 4301113606) |
| Enumeration Date | 2011-03-02 |
| Last Update Date | 2025-01-27 |