| NPI | 1851358956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 20815) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: TX L5584) |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2007-07-08 |