| NPI | 1023244654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: PA MD455236) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: PA DS037962) |
| Enumeration Date | 2009-06-10 |
| Last Update Date | 2022-06-21 |