| NPI | 1306176268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WA DE60620346) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY p65258) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MA DN1855911) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NH 03900) | |
| Enumeration Date | 2009-12-28 |
| Last Update Date | 2016-02-02 |