| NPI | 1245543842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: NE 7127) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: NE 28850) |
| Enumeration Date | 2010-07-23 |
| Last Update Date | 2016-06-29 |