| NPI | 1700936580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: CT 013310) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: GA 013310) |
| Enumeration Date | 2007-01-12 |
| Last Update Date | 2013-06-11 |