| NPI | 1366485484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL DN 18421) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PR 928) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OH 19156) | |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2009-01-30 |