NPI | 1801001516 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: DE G1-0001324) |
Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: PA DS036434) |
Enumeration Date | 2007-05-14 |
Last Update Date | 2016-03-16 |