| NPI | 1952353732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: SC 2143) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: KS 60225) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: GA DN012316) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: KY 6415) | |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2007-07-08 |