| NPI | 1275748097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: GA 71076) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS035364) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PA DS035364) | |
| 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck (Licence: NM MD 20008-0800) | |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2013-12-18 |