NPI | 1417155821 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: VA 0438000245) |
Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 0401412132) |
1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MI 2901018153) | |
Enumeration Date | 2007-07-06 |
Last Update Date | 2018-08-02 |