| NPI | 1184696874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PA DS036534) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS036534) |
| 207L00000X Anesthesiology (Licence: PA DA031677) | |
| Enumeration Date | 2006-02-06 |
| Last Update Date | 2016-06-29 |