| NPI | 1922237981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: PA MD455881) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: PA DS040426) |
| Enumeration Date | 2009-07-10 |
| Last Update Date | 2019-09-26 |