NPI | 1588078224 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: LA 311638) |
Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: LA S-991) |
1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 63027) | |
204E00000X Oral & Maxillofacial Surgery (Licence: CA A158305) | |
Enumeration Date | 2014-06-19 |
Last Update Date | 2019-07-24 |