NPI | 1629337506 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: MN 61209) |
Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: MN D13132) |
Enumeration Date | 2012-05-11 |
Last Update Date | 2017-05-16 |