NPI | 1619997707 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: NE 23254) |
Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: NE 6467) |
Enumeration Date | 2006-07-20 |
Last Update Date | 2015-07-30 |