| NPI | 1467449207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: TX M6345) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: OR MD25735) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX M6345) | |
| Enumeration Date | 2005-10-05 |
| Last Update Date | 2008-10-22 |