| NPI | 1689961385 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL DN27498) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: FL ME131781) |
| Enumeration Date | 2011-07-01 |
| Last Update Date | 2023-12-14 |