| NPI | 1417981739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: LA MD11531R) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: LA 4998) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: LA 11531R) | |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: LA 11531R) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: LA 4998) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: TX 15501) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: TX J8547) | |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2022-02-02 |