| NPI | 1053574517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: MO 2008019427) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2008019427) |
| Enumeration Date | 2008-07-04 |
| Last Update Date | 2015-07-16 |