| NPI | 1598741548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: VA 0438000302) |
| Additional Taxonomies | 122300000X Dentist (Licence: OR D8519) |
| 122300000X Dentist (Licence: VA 0401413499) | |
| Enumeration Date | 2005-12-21 |
| Last Update Date | 2013-04-03 |