| NPI | 1184609018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: MA DN22199) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PA DS030512L) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MA DN22199) | |
| Enumeration Date | 2005-12-14 |
| Last Update Date | 2019-05-09 |