| NPI | 1194896548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OR D6314) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: OR MD13968) |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2007-07-08 |