| NPI | 1760486682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: TN MD24477) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TN DS7016) |
| Enumeration Date | 2005-06-09 |
| Last Update Date | 2009-09-24 |