| NPI | 1407061161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PA DS035811) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS035811) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CO 9437) | |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2012-01-31 |