| NPI | 1568672996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: TX 23739) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: TX N4460) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2018-10-11 |