| NPI | 1649325317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: TX TXBL1046) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: TX TD20047) |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2007-07-08 |