| NPI | 1972522175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: MA 15431) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: VT 920) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2007-07-08 |