NPI | 1194969378 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 103573) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 055232) |
1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WI 1001955) | |
1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY P65488) | |
Enumeration Date | 2009-05-01 |
Last Update Date | 2021-05-25 |