| NPI | 1497984785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: FL DN23064) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: MA D-10615) |
| Enumeration Date | 2009-07-08 |
| Last Update Date | 2021-06-04 |