NPI | 1720241615 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: ND 2085) |
Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 57097) |
204E00000X Oral & Maxillofacial Surgery (Licence: MN D12849) | |
Enumeration Date | 2008-07-09 |
Last Update Date | 2011-12-29 |