| NPI | 1437501079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: FL DN30870) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4351052050) |
| Enumeration Date | 2016-07-07 |
| Last Update Date | 2025-09-05 |