| NPI | 1063480077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX J4124) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX D14502) |
| 1223G0001X Dentist, General Practice (Licence: TX J4124) | |
| 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: TX J4124) | |
| 1223X0008X Dentist, Oral and Maxillofacial Radiology (Licence: TX J4124) | |
| 1223G0001X Dentist, General Practice (Licence: TX D14502) | |
| 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: TX D14502) | |
| 1223X0008X Dentist, Oral and Maxillofacial Radiology (Licence: TX D14502) | |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2008-02-26 |