| NPI | 1588854053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: FL DN18005) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: FL ME129272) |
| Enumeration Date | 2007-07-30 |
| Last Update Date | 2018-10-15 |