| NPI | 1497722664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX K9307) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: ND 8490) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: ND 1910) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 18047) | |
| Enumeration Date | 2006-03-07 |
| Last Update Date | 2008-02-22 |