| NPI | 1013098698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: NC 8919) |
| Additional Taxonomies | 122300000X Dentist (Licence: NC 8919) |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: VA 0401411258) | |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: IL 019022235) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: VA 0101058265) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: NC 8919) | |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2013-08-28 |