| NPI | 1780678466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IA 05935) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WI 5000989015) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 23154) | |
| Enumeration Date | 2005-09-08 |
| Last Update Date | 2007-07-08 |