| NPI | 1639434665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PA DS040658) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NJ 22DI02507400) |
| 207L00000X Anesthesiology (Licence: PA DA031767) | |
| Enumeration Date | 2012-07-05 |
| Last Update Date | 2021-07-06 |