| NPI | 1740204973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: PA DS030125L) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: FL DN15509) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2012-01-24 |