| NPI | 1215190145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: CO DEN00201943) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: IN 12011863A) |
| Enumeration Date | 2008-07-10 |
| Last Update Date | 2013-05-24 |