| NPI | 1750309928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: PA DS036930) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PA TDA000283) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2012-06-28 |