NPI | 1740271915 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: MD 14259) |
Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: MD D67181) |
1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MD 14259) | |
Enumeration Date | 2005-11-04 |
Last Update Date | 2011-06-01 |