| NPI | 1780614883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PA DS021679L) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS028977L) |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2007-07-19 |