| NPI | 1588734438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: FL ME 95024) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL DN 17306) |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2009-10-06 |