| NPI | 1104867431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL ME139554) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IL 019.028191) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: IL 036.125106) | |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2025-06-05 |