| NPI | 1558667980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: MD 8776) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: MD D0041703) |
| Enumeration Date | 2011-02-02 |
| Last Update Date | 2011-08-04 |