| NPI | 1811171754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: AL 5212) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NC 2011-00192) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NC 2011-00192) | |
| 208200000X Plastic Surgery (Licence: AL MD.28817) | |
| Enumeration Date | 2007-12-27 |
| Last Update Date | 2013-01-15 |