| NPI | 1346469079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL DN13778) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL ME71048) |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2007-07-08 |