| NPI | 1669770707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 22415) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: TX N8741) |
| Enumeration Date | 2011-03-12 |
| Last Update Date | 2012-06-29 |