| NPI | 1790803872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: FL DN15151) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: FL ME96006) |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2013-10-25 |