| NPI | 1982872461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CO 10418) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 5935496-9922) |
| Enumeration Date | 2008-02-18 |
| Last Update Date | 2012-01-17 |