| NPI | 1407295546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MI 2901600734) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS039528) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PA DS039528) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 34748) | |
| Enumeration Date | 2013-06-21 |
| Last Update Date | 2023-01-19 |