| NPI | 1871575985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: PA DS022922L) |
| Additional Taxonomies | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: MD 9551) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: PA DS022922L) | |
| Enumeration Date | 2005-11-15 |
| Last Update Date | 2018-10-11 |