| NPI | 1396740023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: MN 8761) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: WI 4374015) |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: WA DE00006557) | |
| Enumeration Date | 2005-06-17 |
| Last Update Date | 2007-07-16 |