NPI | 1629049507 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: FL DN18924) |
Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OH 30021027) |
1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL DN18924) | |
Enumeration Date | 2006-01-30 |
Last Update Date | 2024-10-08 |