| NPI | 1992964795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: KY 9855) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: NY 255991) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: LA MD.205293) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: KY 9855) | |
| Enumeration Date | 2008-06-06 |
| Last Update Date | 2016-09-30 |