NPI | 1528037413 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: OH 30.019063) |
Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 8588) |
1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OH 30.019063) | |
Enumeration Date | 2006-03-14 |
Last Update Date | 2022-04-01 |