| NPI | 1588626659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MO 014586) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: MO R6P66) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: KS 04-29863) | |
| Enumeration Date | 2006-04-04 |
| Last Update Date | 2007-08-03 |