| NPI | 1932450020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 25945) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 30562) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NV S2-43C) | |
| Enumeration Date | 2012-09-28 |
| Last Update Date | 2012-09-28 |