| NPI | 1003038571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: AZ D6136) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: ID D 3765 OS) |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: WA DE00006802) | |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2007-07-08 |