| NPI | 1942321518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: UT 6540390-9924) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: UT 6540390-1205) |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2008-04-16 |