| NPI | 1346418241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: PA DS035586) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: PA MD434079) |
| Enumeration Date | 2008-02-13 |
| Last Update Date | 2012-04-09 |