| NPI | 1720154495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: MD 14962) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS-036775) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: UT 7973638-9924) | |
| 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck (Licence: UT 7973638-1205) | |
| 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck (Licence: TX P2072) | |
| Enumeration Date | 2006-11-27 |
| Last Update Date | 2012-09-11 |