| NPI | 1588816243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WY 1368) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 24005) |
| Enumeration Date | 2008-10-14 |
| Last Update Date | 2015-06-30 |