| NPI | 1477621845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CO 779) |
| Additional Taxonomies | 174400000X Specialist (Licence: CO 20353) |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2008-06-04 |