| NPI | 1952504219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: OH 30.023915) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OH 023915) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: FL DN18025) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: OH 35.121660) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: MA DN1856941) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: MA 264666) | |
| Enumeration Date | 2007-06-06 |
| Last Update Date | 2024-04-10 |