| NPI | 1588608616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: NV 3332-S228) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 101008) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MT 2431) | |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2016-11-02 |