| NPI | 1639299100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: OR MD126317) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OR D9272) |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2016-08-12 |