| NPI | 1073644019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: AR e-1610) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: AR E-1610) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: AR E-1610) | |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2009-12-19 |