| NPI | 1851602734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL DN20097) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: FL ME126871) |
| Enumeration Date | 2010-06-25 |
| Last Update Date | 2021-05-17 |