| NPI | 1255416459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 22911) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL DN 20469) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: CA A137085) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: FL ME 114524) | |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2022-08-11 |