NPI | 1154676518 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: TX Q1227) |
Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: TX 28690) |
Enumeration Date | 2012-07-20 |
Last Update Date | 2016-02-12 |