NPI | 1568788925 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: MO 2014006169) |
Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MO 2014015503) |
Enumeration Date | 2010-04-10 |
Last Update Date | 2014-09-07 |