NPI | 1649264466 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: MD 13271) |
Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MD 13271) |
1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: DC DEN6006) | |
Enumeration Date | 2005-09-08 |
Last Update Date | 2013-09-23 |