| NPI | 1174968549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: MA DN1858223) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: VT 016.0133894) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: NH 04481) | |
| Enumeration Date | 2013-04-30 |
| Last Update Date | 2022-12-15 |