| NPI | 1326048133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 10478) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: TX G5821) |
| Enumeration Date | 2005-07-22 |
| Last Update Date | 2007-07-08 |