| NPI | 1730138371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PA DS017817-L) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PA DA017817A) |
| 122300000X Dentist (Licence: FL DN5723) | |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2009-11-20 |