| NPI | 1366409799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: PA DS030642L) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: PA DS030642L) |
| 207L00000X Anesthesiology (Licence: PA DA031589) | |
| Enumeration Date | 2006-04-28 |
| Last Update Date | 2021-01-25 |