| NPI | 1740349448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: NC 201201857) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PA DS036277) |
| Enumeration Date | 2006-12-08 |
| Last Update Date | 2018-01-03 |