| NPI | 1932429198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PA DS038289) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS038289) |
| 122300000X Dentist (Licence: NJ 22DI02450700) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NJ 22DI02450700) | |
| Enumeration Date | 2010-06-09 |
| Last Update Date | 2022-07-21 |