| NPI | 1760619118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: AK 1409) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 53734) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: AZ 6568) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: HI 2216) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OH 30-023618) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OH 099021) | |
| Enumeration Date | 2009-06-12 |
| Last Update Date | 2013-03-07 |