NPI | 1245215821 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: MD 10013) |
Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: MD 10013) |
204E00000X Oral & Maxillofacial Surgery (Licence: DC DEN4886) | |
Enumeration Date | 2005-12-07 |
Last Update Date | 2022-07-19 |