| NPI | 1952556805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PA DS036796) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 0401413476) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: VA 0101251380) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: PA MD455041) | |
| Enumeration Date | 2008-11-19 |
| Last Update Date | 2016-02-25 |