| NPI | 1992313357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS042795) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: LA 7458) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: LA 347504) | |
| Enumeration Date | 2020-07-21 |
| Last Update Date | 2025-11-17 |