| NPI | 1316921745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: AL 15364) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: AL 4071) |
| Enumeration Date | 2005-11-30 |
| Last Update Date | 2010-09-22 |