| NPI | 1225202484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: GA DN015554) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: FL ME119237) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: GA DNGA000670) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: GA 79392) | |
| 208600000X Surgery (Licence: NC 2018-02491) | |
| Enumeration Date | 2008-04-18 |
| Last Update Date | 2022-03-29 |