| NPI | 1457337982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: VA 0438000313) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: LA 6025) |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: MD 13440) | |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: DC DEN1001258) | |
| Enumeration Date | 2005-12-16 |
| Last Update Date | 2014-05-22 |