| NPI | 1780607366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: CT 9219) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: CT 41799) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2007-07-08 |