| NPI | 1952557852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: PA DS038201) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: NJ 22DI02723800) |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: KY 10037) | |
| Enumeration Date | 2008-08-11 |
| Last Update Date | 2023-11-16 |