| NPI | 1902823792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: VA 0438000214) |
| Additional Taxonomies | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: MD 12587) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 0401411275) | |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: VA 0101236322) | |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2018-05-23 |