| NPI | 1538104682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WA 8226) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OH 30021548) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IL 19026807) | |
| Enumeration Date | 2006-06-20 |
| Last Update Date | 2007-08-02 |