NPI | 1477000164 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: OR MD219104) |
Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OR D10527) |
Enumeration Date | 2016-09-09 |
Last Update Date | 2025-07-17 |