| NPI | 1649567918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL ME105271) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: FL ME 105271) |
| Enumeration Date | 2011-07-06 |
| Last Update Date | 2023-08-15 |