| NPI | 1427189224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MS 3119-00) |
| Additional Taxonomies | 174400000X Specialist (Licence: MS OS-340-00) |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2007-07-08 |