| NPI | 1386788479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: MA DN1855357) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MA DN1855357) |
| 207Y00000X Otolaryngology (Licence: MA 243606) | |
| 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: MA 243606) | |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2013-03-14 |