NPI | 1730145061 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: FL ME74506) |
Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: FL DN 13112) |
Enumeration Date | 2006-04-25 |
Last Update Date | 2023-07-09 |