| NPI | 1053391102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MA 12181) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MA 41951) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NH 2208) | |
| Enumeration Date | 2006-01-17 |
| Last Update Date | 2007-11-28 |