| NPI | 1598724825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: FL DN11625) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL ME61080) |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2013-05-31 |