| NPI | 1952374761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: CA 60084) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: NJ 22DI02230300) |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: TX 23691) | |
| Enumeration Date | 2006-02-10 |
| Last Update Date | 2012-04-04 |