| NPI | 1285772301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CO 10136) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: CO 50000) |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2017-01-18 |