| NPI | 1073898516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: PA DS038935) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PA DS038935) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: PA MD471966) | |
| Enumeration Date | 2011-10-16 |
| Last Update Date | 2022-11-22 |