| NPI | 1932261138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NJ DI02276500) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: PA DS035766) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: PA MD431861) | |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2012-09-04 |