| NPI | 1265519417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: AZ AZ2288) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MO 00280274) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NM 1220) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2007-07-08 |