| NPI | 1629395264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PA DS039439) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD457711) |
| Enumeration Date | 2010-04-21 |
| Last Update Date | 2021-02-26 |