| NPI | 1528101698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: AL 4438) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: AL 20060) |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2012-08-16 |