NPI | 1063492981 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: UT 6632857) |
Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: AL 5134) |
1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WA DE00010382) | |
Enumeration Date | 2006-01-18 |
Last Update Date | 2023-05-22 |