| NPI | 1811187172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: VA 0101266069) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN 18021) |
| 122300000X Dentist (Licence: TX 25879) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 0438000396) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: TX Q4372) | |
| Enumeration Date | 2007-08-01 |
| Last Update Date | 2021-09-24 |