| NPI | 1336386325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 04014143467) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101255779) |
| Enumeration Date | 2009-01-13 |
| Last Update Date | 2015-01-27 |