| NPI | 1679861942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: PA DS041746) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: PA DS041746) |
| Enumeration Date | 2011-07-20 |
| Last Update Date | 2020-12-10 |