| NPI | 1720526619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PA DS042016) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MD 18388) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 0401419134) | |
| Enumeration Date | 2017-02-10 |
| Last Update Date | 2024-10-16 |