| NPI | 1447343918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL DN 12910) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: FL ME59580) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2014-11-17 |