| NPI | 1528222080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PA DS039419) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: NY 059477) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: PA DS039419) | |
| Enumeration Date | 2008-07-14 |
| Last Update Date | 2020-08-17 |