| NPI | 1265690028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: UT 7752965) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: ID D-4552-OS) |
| Enumeration Date | 2008-05-29 |
| Last Update Date | 2016-10-31 |