| NPI | 1912998410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 23704) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MS 2168-85) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL DN11031) | |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2008-09-18 |