| NPI | 1023088143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 28274) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CO 7425) |
| 122300000X Dentist (Licence: TX 28274) | |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2015-01-06 |