| NPI | 1457444143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: TX 17375) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 17375) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2007-07-31 |