NPI | 1730180043 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: MD D0041559) |
Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MD 11181) |
2086S0127X Surgery, Trauma Surgery (Licence: MD D0041559) | |
Enumeration Date | 2005-08-09 |
Last Update Date | 2009-10-02 |