NPI | 1326048133 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 10478) |
Additional Taxonomies | 207Y00000X Otolaryngology (Licence: TX G5821) |
Enumeration Date | 2005-07-22 |
Last Update Date | 2007-07-08 |