| NPI | 1942287875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IA 08393) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: MN 47958) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WI 5844015) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MN D11448) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IL 019026707) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: IA 36804) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: WI 49434020) | |
| Enumeration Date | 2005-12-30 |
| Last Update Date | 2011-02-10 |