NPI | 1538303144 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: WA 60478567) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
282NC0060X General Acute Care Hospital, Critical Access (Licence: WA 60478567) | |
Enumeration Date | 2009-04-27 |
Last Update Date | 2014-10-30 |