NPI | 1639338304 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: WV 3957) |
Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: MD 16311) |
Enumeration Date | 2008-06-06 |
Last Update Date | 2018-06-06 |