| NPI | 1245414036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PA DS306794) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA ds306794) |
| Enumeration Date | 2007-12-28 |
| Last Update Date | 2018-10-25 |