| NPI | 1417041104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TN DS0000009783) |
| Additional Taxonomies | 122300000X Dentist (Licence: SC 4033) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL dn18907) | |
| 122300000X Dentist (Licence: NY 053467) | |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2014-04-29 |