| NPI | 1861557837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL TRN#15897) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NV LL-0097-06) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL DRP551) | |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2011-06-21 |