| NPI | 1558881763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: FL ME168164) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: FL DN27768) |
| Enumeration Date | 2017-06-20 |
| Last Update Date | 2024-06-25 |