| NPI | 1508124363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WV 4592) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL dn20042) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WV 31800) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MI 2901600263) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL DN20042) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: FL TRN23463) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: MI 4301116139) | |
| Enumeration Date | 2012-04-30 |
| Last Update Date | 2022-10-02 |