| NPI | 1710964028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: MA 1855672) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MA 1855672) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: NH 04127) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VT 0160066233) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NH 04127) | |
| Enumeration Date | 2005-12-28 |
| Last Update Date | 2023-12-27 |