| NPI | 1174530562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NC 7871) |
| Additional Taxonomies | 174400000X Specialist (Licence: NC 200400221) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2007-07-08 |