| NPI | 1316992852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL MD13453) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL 10596) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TN ME0041059) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MA 17067) | |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2007-07-08 |