NPI | 1477718229 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WA de 60498667) |
Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PA ds038644) |
Enumeration Date | 2008-07-22 |
Last Update Date | 2015-09-02 |