| NPI | 1376866186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME138252) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: FL DN24026) |
| Enumeration Date | 2010-03-08 |
| Last Update Date | 2021-01-29 |