| NPI | 1902885668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 0401418436) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PA DS-024817-L) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: VA 0401418436) | |
| Enumeration Date | 2006-01-11 |
| Last Update Date | 2023-08-24 |