| NPI | 1932272705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: FL me88676) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: FL dn16453) |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2007-07-08 |