NPI | 1235666843 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: SC 10306) |
Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: SC 10255) |
Enumeration Date | 2017-05-12 |
Last Update Date | 2024-04-18 |