| NPI | 1720093230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: OR MD23291) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: OR DF0014) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2007-07-08 |