| NPI | 1396723698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NC 10205) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS035738) |
| Enumeration Date | 2006-01-06 |
| Last Update Date | 2023-03-03 |