| NPI | 1558643908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: PA DS038990) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: NJ 22DI02841600) |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: NJ 22DI02841600) | |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: PA DS083990) | |
| Enumeration Date | 2011-09-12 |
| Last Update Date | 2024-07-21 |