| NPI | 1386679322 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CT 009496) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NH 3514) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 054511) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MA 21347) | |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2013-03-04 |