| NPI | 1679776603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OR D8674) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OR MD 26175) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: LA 5220) | |
| Enumeration Date | 2007-06-07 |
| Last Update Date | 2014-08-22 |