NPI | 1255306866 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: FL ME77063) |
Additional Taxonomies | 208600000X Surgery (Licence: FL ME77063) |
1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL DN15027) | |
Enumeration Date | 2006-02-18 |
Last Update Date | 2014-01-21 |