| NPI | 1093780603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: FL ME85119) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DTP368) |
| Enumeration Date | 2006-02-18 |
| Last Update Date | 2008-04-29 |