| NPI | 1629390109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086X0206X Surgery Surgical Oncology (Licence: FL ME158070) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: WA 61196733) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: FL DN24666) | |
| 208600000X Surgery (Licence: NC 220893) | |
| 208600000X Surgery (Licence: LA GETP201569) | |
| 2086X0206X Surgery Surgical Oncology (Licence: FL DRPM2024) | |
| 2086X0206X Surgery Surgical Oncology (Licence: WA 61233201) | |
| 2086X0206X Surgery Surgical Oncology (Licence: WA MD61201474) | |
| Enumeration Date | 2010-02-24 |
| Last Update Date | 2022-07-20 |