| NPI | 1629173711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: ME 3009) |
| Additional Taxonomies | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: ME 3009) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: ME 3009) | |
| 1223X0008X Dentist, Oral and Maxillofacial Radiology (Licence: ME 3009) | |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2018-03-17 |