| NPI | 1467832782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WI 1001147) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901021509) |
| Enumeration Date | 2015-06-02 |
| Last Update Date | 2015-07-02 |