NPI | 1215101209 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 28461) |
Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: TX Q6702) |
Enumeration Date | 2008-04-21 |
Last Update Date | 2018-10-22 |