| NPI | 1124264023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PA DS037904) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: PA MT191779) |
| Enumeration Date | 2008-12-23 |
| Last Update Date | 2012-03-06 |