| NPI | 1306073754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL DN 21029) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL DRP781) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: FL ME119684) | |
| Enumeration Date | 2009-06-12 |
| Last Update Date | 2015-02-23 |