NPI | 1376705087 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: LA 6460) |
Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: MS 3464-08 / OS-481-14) |
Enumeration Date | 2008-06-25 |
Last Update Date | 2014-07-14 |