| NPI | 1609000314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 0024679) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 24679) |
| 122300000X Dentist (Licence: OH 30.022272) | |
| 208600000X Surgery (Licence: TX N4160) | |
| Enumeration Date | 2009-05-08 |
| Last Update Date | 2013-01-07 |