| NPI | 1093785511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: PA DA030841A) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: PA DS030841L) |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2019-01-14 |