| NPI | 1558479253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: GA DN012694) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: SC 3173) |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2007-07-08 |