| NPI | 1538228580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CO 9258) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: CO DR-45157) |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2013-03-06 |