| NPI | 1013174168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: WA DE60745807) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: NY 054384) |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: CA 61526) | |
| Enumeration Date | 2008-05-16 |
| Last Update Date | 2017-04-26 |