| NPI | 1124000575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL DN17270) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: PA DS030473L) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: FL DN17270) | |
| Enumeration Date | 2005-11-18 |
| Last Update Date | 2017-04-17 |