| NPI | 1710090758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 12953) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: TX H2317) |
| 207Q00000X Family Medicine (Licence: TX H2317) | |
| 207Q00000X Family Medicine (Licence: MI 084143) | |
| 208200000X Plastic Surgery (Licence: TX H2317) | |
| 208200000X Plastic Surgery (Licence: MI 084143) | |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2007-07-08 |