| NPI | 1619901600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: PA DS035466) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA DS035466) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2018-08-16 |