| NPI | 1760513121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: UT 1328489924) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 21607) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NV S259C) | |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2010-02-17 |