| NPI | 1669442828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: VA 0401412104) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: PA DS025234L) |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2009-07-15 |