| NPI | 1093978710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: TX q6332) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 30749) |
| Enumeration Date | 2008-07-02 |
| Last Update Date | 2016-10-10 |