| NPI | 1528173234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WI 5578015) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: WI 48605) |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2011-01-13 |