| NPI | 1609938406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: ME 3426) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NH 3224) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: ME DEN3426) | |
| Enumeration Date | 2006-12-15 |
| Last Update Date | 2014-01-23 |