| NPI | 1013947936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CT 003716) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: CT 3716) |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2013-12-20 |