NPI | 1356459028 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: FL DN16376) |
Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: FL DN16376) |
Enumeration Date | 2006-08-25 |
Last Update Date | 2019-07-16 |