NPI | 1124030085 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: AK 106) |
Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: KY 9881) |
Enumeration Date | 2006-08-12 |
Last Update Date | 2023-03-07 |