| NPI | 1467624973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 23935) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: LA 207796) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX q0829) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: AZ 50203) | |
| Enumeration Date | 2008-03-25 |
| Last Update Date | 2018-12-12 |