| NPI | 1023049285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: MO 015302) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: MO 2001004435) |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2017-02-15 |