| NPI | 1134295389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NE 16420) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NE 4560) |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2007-07-08 |