NPI | 1427194364 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: ND T2400) |
Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NM DD2840) |
1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WY 1160) | |
1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 12562) | |
Enumeration Date | 2007-01-29 |
Last Update Date | 2020-07-13 |