| NPI | 1134258817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: MD D64569) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MI 2901017877) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: MI 4301083994) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MD 71) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: OR MD29070) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: PA MD431734) | |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2010-07-08 |