| NPI | 1154338101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NM DD3842) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: TX 95-367) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 28634) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 055441-1) | |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2013-04-04 |