NPI | 1538129978 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: MA 0016765) |
Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: CT 007615) |
Enumeration Date | 2006-03-27 |
Last Update Date | 2007-07-08 |