| NPI | 1316111941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: DC DEN100380) |
| Additional Taxonomies | 122300000X Dentist (Licence: DC DEN1000380) |
| Enumeration Date | 2008-04-15 |
| Last Update Date | 2008-04-15 |