| NPI | 1154555035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: GA DN123170) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL DTP618) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: KY 8715) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: FL ME124338) | |
| Enumeration Date | 2009-05-07 |
| Last Update Date | 2024-02-20 |