| NPI | 1619919685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PA DA 026947 A) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PA DS 026947 L) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 046057-1) | |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2016-01-07 |