NPI | 1194032284 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: TX R0626) |
Additional Taxonomies | 122300000X Dentist (Licence: TX 25460) |
Enumeration Date | 2010-09-10 |
Last Update Date | 2016-12-01 |