| NPI | 1316937634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MO 015607) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2000163887) |
| Enumeration Date | 2005-10-27 |
| Last Update Date | 2017-12-15 |