| NPI | 1659442325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MA 20205) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL DN16305) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PA DS035268) | |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2007-07-08 |