| NPI | 1336322346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: CO DEN-10498) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: UT 7651456-9921) |
| Enumeration Date | 2007-12-12 |
| Last Update Date | 2011-07-21 |