| NPI | 1629579628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL DN29481) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: FL ME170566) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 40790) | |
| Enumeration Date | 2018-02-24 |
| Last Update Date | 2025-07-17 |