| NPI | 1427153840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PA DS039481) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KY 8408) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WV 4017) | |
| 122300000X Dentist (Licence: PA DS039481) | |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2014-02-27 |