| NPI | 1952386146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MD 15497) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 59322109921) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NV S2-148) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: UT 5932210-9921) | |
| Enumeration Date | 2005-12-09 |
| Last Update Date | 2018-04-25 |