| NPI | 1295782555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WI 5000545-015) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: WI 5000545-015) |
| Enumeration Date | 2006-05-30 |
| Last Update Date | 2011-10-21 |