| NPI | 1417946898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: MA 20616) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: RI DEN2741) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: MA 219515) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: RI MD10576) | |
| Enumeration Date | 2005-10-18 |
| Last Update Date | 2007-07-08 |