| NPI | 1245231810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 9735) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: TX E4478) |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2009-07-20 |