| NPI | 1467694471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: PA DS039058) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PA DA031685) |
| Enumeration Date | 2009-04-06 |
| Last Update Date | 2017-01-04 |