| NPI | 1598919185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: TX 22613) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: TX 22613) |
| Enumeration Date | 2008-11-09 |
| Last Update Date | 2015-10-23 |