| NPI | 1356305569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: TN DS0000009088) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: OH 30021966) |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: MD 14057) | |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2010-06-25 |