| NPI | 1356366611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WV 123) |
| Additional Taxonomies | 122300000X Dentist (Licence: WV 3691) |
| 122300000X Dentist (Licence: VA 04010006256) | |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2009-04-10 |