| NPI | 1295916450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: TX 24237) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX N4439) |
| 208600000X Surgery (Licence: TX N4439) | |
| Enumeration Date | 2007-11-16 |
| Last Update Date | 2012-11-19 |