NPI | 1356320576 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: MN 50992) |
Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MN 11819) |
1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OR D9087) | |
204E00000X Oral & Maxillofacial Surgery (Licence: OR MD29162) | |
Enumeration Date | 2006-01-16 |
Last Update Date | 2009-04-18 |