| NPI | 1356322838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MO 015798) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 114534) |
| Enumeration Date | 2005-11-10 |
| Last Update Date | 2016-03-21 |