| NPI | 1194987040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PA DS035911) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PA DA031627) |
| Enumeration Date | 2008-07-01 |
| Last Update Date | 2009-04-06 |