| NPI | 1508966961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PA DS042379) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: KY 7704) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: KY 7704) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: PA DS042379) | |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2020-03-05 |