| NPI | 1790768562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: WV 116) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: WV 3542) |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: PA DS036241) | |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: MA 19714) | |
| Enumeration Date | 2005-11-25 |
| Last Update Date | 2007-07-08 |