| NPI | 1750592770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: SC 9514) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PA DS038197) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 051226) | |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2020-12-24 |