NPI | 1104205806 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: CA 107694) |
Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PA DS040657) |
204E00000X Oral & Maxillofacial Surgery (Licence: PA DS040657) | |
Enumeration Date | 2015-05-27 |
Last Update Date | 2024-06-19 |