NPI | 1700176625 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: AL 5887) |
Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: AL 35969) |
Enumeration Date | 2011-04-12 |
Last Update Date | 2018-03-17 |