NPI | 1265654784 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: MA 21822) |
Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MA 21822) |
Enumeration Date | 2007-05-03 |
Last Update Date | 2019-10-01 |