| NPI | 1114241452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PA DS038427) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 053462-1) |
| Enumeration Date | 2010-03-15 |
| Last Update Date | 2013-02-21 |