| NPI | 1760613426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: FL ME101326) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: FL DN16048) |
| Enumeration Date | 2009-07-29 |
| Last Update Date | 2024-03-14 |