| NPI | 1386837797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: MA DN1855325) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: MA 243366) |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: NH 03764) | |
| Enumeration Date | 2007-08-20 |
| Last Update Date | 2011-06-08 |