| NPI | 1629049507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: FL DN18924) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OH 30021027) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL DN18924) | |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2023-02-07 |