| NPI | 1598927196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: SC 86996) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: FL ME138798) |
| Enumeration Date | 2008-06-26 |
| Last Update Date | 2022-07-07 |