| NPI | 1407878606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: GA DN013387) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: FL DN7757) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: GA DNGA000215) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: CA DDS25997) | |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2021-03-22 |