| NPI | 1013946540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: PA MD418924) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: PA DS031585L) |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2013-04-10 |