NPI | 1235663113 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: NC 10659) |
Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: PA MD481288) |
Enumeration Date | 2017-04-17 |
Last Update Date | 2025-05-23 |