| NPI | 1326104076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: OR D8179) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: WA DE00005871) |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: ID D-3945-OS) | |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2015-04-20 |