| NPI | 1730292517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: FL DN15568) |
| Additional Taxonomies | 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck (Licence: FL DN15568) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL DN15568) | |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2026-05-29 |