NPI | 1184678930 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: MA DN1855832) |
Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MA DN1855832) |
Enumeration Date | 2006-05-19 |
Last Update Date | 2019-05-09 |