| NPI | 1730180043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: MD D0041559) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MD 11181) |
| 2086S0127X Surgery, Trauma Surgery (Licence: MD D0041559) | |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2009-10-02 |