| NPI | 1992843437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: CT 009672) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: CT 45907) |
| Enumeration Date | 2007-02-04 |
| Last Update Date | 2010-04-09 |