NPI | 1699796318 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: MA 19432) |
Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: VT 2063) |
Enumeration Date | 2006-07-21 |
Last Update Date | 2023-12-27 |