| NPI | 1841208303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: OR D5351) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: OR MD11705) |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2007-07-20 |