| NPI | 1720154495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: DC DEN1001223) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: MD 14962) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: DC MD044528) | |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: MD D0075315) | |
| Enumeration Date | 2006-11-27 |
| Last Update Date | 2024-11-14 |