| NPI | 1962545947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: MD D0066077) |
| Additional Taxonomies | 2086S0127X Surgery, Trauma Surgery (Licence: MD D0066077) |
| 122300000X Dentist (Licence: MD 61 (Teaching)) | |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2008-02-20 |