| NPI | 1144206798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: NC 09973) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS03578) |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: GA DN014565) | |
| Enumeration Date | 2005-12-15 |
| Last Update Date | 2016-06-29 |