| NPI | 1114903739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 0401412914) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IN 12010200A) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WA DE00011016) | |
| Enumeration Date | 2005-12-15 |
| Last Update Date | 2010-08-23 |