NPI | 1609295336 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: VA 0438000388) |
Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 0401416021) |
Enumeration Date | 2014-04-09 |
Last Update Date | 2024-01-29 |