| NPI | 1205814407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WI 6871) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 13769) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WA DE00008885) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MN D13296) | |
| Enumeration Date | 2006-01-06 |
| Last Update Date | 2016-02-08 |