NPI | 1154422947 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: CT 035135) |
Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: CT 08215) |
Enumeration Date | 2006-09-26 |
Last Update Date | 2010-03-30 |