| NPI | 1528366473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL DN24368) |
| Additional Taxonomies | 122300000X Dentist (Licence: NE 6882) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MI 2901020622) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 060336) | |
| Enumeration Date | 2011-03-02 |
| Last Update Date | 2020-05-13 |