| NPI | 1356322531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: ME MD17348) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 7105) |
| Enumeration Date | 2005-11-07 |
| Last Update Date | 2015-05-29 |