| NPI | 1073771440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MD 14467) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT189448) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PA DS035888) | |
| Enumeration Date | 2008-06-02 |
| Last Update Date | 2009-07-14 |