| NPI | 1740271915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: MD 14259) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: MD D67181) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MD 14259) | |
| Enumeration Date | 2005-11-04 |
| Last Update Date | 2011-06-01 |