| NPI | 1679675508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MS 3067-98) |
| Additional Taxonomies | 122300000X Dentist (Licence: MS 3067-98) |
| Enumeration Date | 2006-09-01 |
| Last Update Date | 2013-07-16 |