NPI | 1063609030 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: CA A102021) |
Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 48850) |
207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: CA A102021) | |
Enumeration Date | 2007-10-03 |
Last Update Date | 2008-08-27 |