| NPI | 1174509665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TN DS0000005348) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: TN MD0000035690) |
| Enumeration Date | 2005-12-16 |
| Last Update Date | 2007-07-08 |