| NPI | 1598931735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: GA 88953) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: LA MD.205951) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: OK 34607) | |
| 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: OK 34607) | |
| 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: OK 34607) | |
| 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: GA 88953) | |
| Enumeration Date | 2008-05-07 |
| Last Update Date | 2021-08-24 |