NPI | 1760565956 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: CA a93114) |
Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA OMS65) |
Enumeration Date | 2006-10-23 |
Last Update Date | 2014-01-13 |