| NPI | 1013941459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: AZ 1556) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MO 11703) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NM 950) | |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2007-07-08 |