NPI | 1659448108 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX m4965) |
Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 22097) |
204E00000X Oral & Maxillofacial Surgery (Licence: TX M4965) | |
Enumeration Date | 2006-11-29 |
Last Update Date | 2023-02-23 |