NPI | 1598927196 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: SC 86996) |
Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: FL ME138798) |
Enumeration Date | 2008-06-26 |
Last Update Date | 2022-07-07 |