| NPI | 1730169459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: NC 2005-01600) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 6486) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: IN 01056641A) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: MD D0066918) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: FL ME109928) | |
| Enumeration Date | 2006-01-19 |
| Last Update Date | 2012-12-03 |