| NPI | 1033211099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: WI 6344-15) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: MA 20002) |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: WI 52824-20) | |
| Enumeration Date | 2006-09-01 |
| Last Update Date | 2010-04-14 |