| NPI | 1932183340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: PA MD023594-E) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: PA 023594-E) |
| Enumeration Date | 2005-11-30 |
| Last Update Date | 2007-07-08 |