NPI | 1558688309 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: LA MD.302913) |
Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: TX U0177) |
Enumeration Date | 2010-05-03 |
Last Update Date | 2023-05-10 |