| NPI | 1164514402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL DN24404) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PA DS028494L) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: PA DS028494L) | |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2020-08-04 |