| NPI | 1982649356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: PA DS035317) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: PA DS 035317) |
| Enumeration Date | 2006-06-18 |
| Last Update Date | 2012-05-23 |