| NPI | 1154760411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: FL ME144719) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NE 7135) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL DN25920) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: NE 7135) | |
| Enumeration Date | 2013-06-20 |
| Last Update Date | 2024-01-08 |