| NPI | 1306802665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: AL LNO4865) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: AL 00020694) |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2007-07-08 |