| NPI | 1831289099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MD 10794) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: FL ME72794) |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2025-07-09 |