| NPI | 1295766566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NE 3866) |
| Additional Taxonomies | 174400000X Specialist (Licence: NE 12945) |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2007-07-09 |