| NPI | 1679540710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CO 8616) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 18444) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IL 019-020123) | |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2007-07-08 |