| NPI | 1568410983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: RI DEN02806) |
| Additional Taxonomies | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: MA 20790) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: RI MD11581) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: MA 222855) | |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2007-07-08 |