| NPI | 1689716094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: FL DN10433) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: FL ME57190) |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2012-02-02 |