| NPI | 1528284916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NC 8803) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MS OS36302) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: NC 2009-01628) | |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2010-10-13 |