| NPI | 1366474314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PA MD422877) |
| Additional Taxonomies | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: PA DS035655) |
| 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: PA MD422877) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PA DS035655) | |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2023-09-12 |