| NPI | 1538143128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MA 20897) |
| Additional Taxonomies | 174400000X Specialist (Licence: MA 20897) |
| Enumeration Date | 2005-12-06 |
| Last Update Date | 2015-09-04 |