| NPI | 1174521843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 12382) |
| Additional Taxonomies | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: TX 12382) |
| 1223X0008X Dentist, Oral and Maxillofacial Radiology (Licence: TX 12382) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: TX 12382) | |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2007-07-30 |