| NPI | 1861467078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: FL ME93053) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DTP453) |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: AL D0004920) | |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: GA DN123287) | |
| 208600000X Surgery (Licence: FL ME93053) | |
| Enumeration Date | 2006-02-21 |
| Last Update Date | 2024-01-11 |