| NPI | 1952670580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 27904) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2011041494) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PA DS039066) | |
| Enumeration Date | 2011-12-28 |
| Last Update Date | 2012-09-04 |