| NPI | 1669570388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MI 2901015710) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901015710) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2014-04-04 |