| NPI | 1255306866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: FL ME77063) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME77063) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL DN15027) | |
| Enumeration Date | 2006-02-18 |
| Last Update Date | 2014-01-21 |