| NPI | 1710988993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CT 11051) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: DE G1-0001298) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PA DS036182) | |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2013-12-06 |