| NPI | 1659690576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: FL ME128004) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL ME128004) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL DRP838) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: FL DRP838) | |
| Enumeration Date | 2010-05-18 |
| Last Update Date | 2023-03-23 |