| NPI | 1023230927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: MI 4301097470) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901019126) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MI 2901019126) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: FL ME112441) | |
| 208D00000X General Practice (Licence: MI 4301097470) | |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2024-04-30 |