| NPI | 1043538705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PA DS038552) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: PA MT207339) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VT 016.0125577) | |
| Enumeration Date | 2010-05-05 |
| Last Update Date | 2017-01-20 |