| NPI | 1588614804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: TN DS0000008427) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: TN 40738) |
| 2082S0099X Plastic Surgery Plastic Surgery Within the Head and Neck (Licence: TN 40738) | |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2024-04-24 |