NPI | 1740458389 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: PA MD449368) |
Additional Taxonomies | 122300000X Dentist (Licence: OH 30.022637) |
Enumeration Date | 2008-02-18 |
Last Update Date | 2020-10-02 |