| NPI | 1023338845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: PA MD458839) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: PA DS037996) |
| Enumeration Date | 2010-06-03 |
| Last Update Date | 2018-02-24 |