| NPI | 1841268257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: PA DS027267L) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PA DA027267A) |
| Enumeration Date | 2006-03-10 |
| Last Update Date | 2019-04-16 |