| NPI | 1881784940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MD 14139) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: DC DEN1000668) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 0401412963) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 052925-1) | |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2011-09-20 |