| NPI | 1073601951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086X0206X Surgery, Surgical Oncology (Licence: TX P8484) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: TX P8484) |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2016-06-26 |