| NPI | 1992063093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: MN D13762) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: OR PG173069) |
| 122300000X Dentist (Licence: OR D9768) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WA DE60827554) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OR D9768) | |
| Enumeration Date | 2012-04-26 |
| Last Update Date | 2023-10-11 |