| NPI | 1083714737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WI 5464) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: WI 5464) |
| Enumeration Date | 2006-09-23 |
| Last Update Date | 2007-07-08 |