| NPI | 1639151988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PA DS022282L) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: PA MD038550E) |
| Enumeration Date | 2005-11-14 |
| Last Update Date | 2007-07-08 |