| NPI | 1073834248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL DN22298) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: CA A141168) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: MA DL-10923) | |
| Enumeration Date | 2010-06-22 |
| Last Update Date | 2021-01-27 |