| NPI | 1215010285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: WV 2483) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: MD 6261) |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: PA DS030508L) | |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2012-05-30 |