| NPI | 1275592701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 22601) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: AR 3376) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NJ 22DI02030800) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: AR 60) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: TX K8654) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: AR E3009) | |
| Enumeration Date | 2006-03-22 |
| Last Update Date | 2007-07-26 |