| NPI | 1093839771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PR 2043) |
| Additional Taxonomies | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: FL DN 13518) |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2016-10-19 |