| NPI | 1023185261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: TX F5162) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: TX 9189) |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2016-04-14 |