| NPI | 1275566804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: DC DEN2642) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MD 4894) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 0401004337) | |
| Enumeration Date | 2006-07-08 |
| Last Update Date | 2008-11-19 |