| NPI | 1407836927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: MA 18972) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: MA 150682) |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: NH 2777) | |
| Enumeration Date | 2006-01-19 |
| Last Update Date | 2007-11-28 |