| NPI | 1447364666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: NC NC3265) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: VA 0401008299) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: FL DN6002) | |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2007-11-01 |