NPI | 1366698490 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: AZ 7396) |
Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 55257) |
Enumeration Date | 2008-08-08 |
Last Update Date | 2010-06-04 |