| NPI | 1174683254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: MO 2005005794) |
| Additional Taxonomies | 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck (Licence: MO 2005005794) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MO 2005005794) | |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2026-02-05 |