| NPI | 1285613240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: MO 2005027155) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MO 016083) |
| 208D00000X General Practice (Licence: MO 2005027155) | |
| 122300000X Dentist (Licence: MO 016083) | |
| Enumeration Date | 2006-01-10 |
| Last Update Date | 2012-07-30 |