| NPI | 1922291335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: PA MD439011) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PA DS036793) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: PA DS036793) | |
| Enumeration Date | 2007-08-20 |
| Last Update Date | 2023-07-25 |