| NPI | 1386713725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery |
| 208600000X Surgery | |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2008-03-12 |