NPI | 1689620155 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: AL 5144) |
Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: AL 5144 (Dental)) |
Enumeration Date | 2006-05-26 |
Last Update Date | 2016-01-27 |