| NPI | 1942407812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: MD D0078954) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA ds037712) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MD 15736) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PA DS-037712) | |
| Enumeration Date | 2007-07-02 |
| Last Update Date | 2023-02-23 |