| NPI | 1649306622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: FL DTP739) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: MD 10834) |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2021-08-24 |