| NPI | 1669610044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL DN19281) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 055365-1) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PR 001) | |
| Enumeration Date | 2009-01-23 |
| Last Update Date | 2018-03-17 |