| NPI | 1811067952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MD 12507) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WV 3550) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: DC DEN5975) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PA DS035393) | |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2012-11-02 |