| NPI | 1578799862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: PA MD456122) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PA DS037873) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: PA DS037873) | |
| Enumeration Date | 2009-06-02 |
| Last Update Date | 2019-09-26 |