| NPI | 1720199805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: PA DS020803L) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: NJ 22DI01160800) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2010-06-30 |