| NPI | 1760430730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: RI MD09730) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: RI 02552) |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2012-03-01 |