| NPI | 1588874903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: NC 2011-00545) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: TN 9283) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: TN 47509) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: NC 2011-00545) | |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2012-09-03 |