| NPI | 1013139567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PA DA031698) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 5151071-9923) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2020-08-17 |