| NPI | 1447547427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MD 17649) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 17649) |
| 208600000X Surgery (Licence: PA MT-199807) | |
| Enumeration Date | 2011-06-29 |
| Last Update Date | 2022-01-05 |