| NPI | 1558707505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA DS038348) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: PA MD478919) |
| Enumeration Date | 2013-05-17 |
| Last Update Date | 2022-11-22 |