NPI | 1013418185 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: FL 166526) |
Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL 29367) |
204E00000X Oral & Maxillofacial Surgery (Licence: NY 318937) | |
Enumeration Date | 2018-02-23 |
Last Update Date | 2025-08-02 |