| NPI | 1134132715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: AZ D07194) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ D07194) |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2015-01-21 |