NPI | 1851499529 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: RI DEN03045) |
Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 041673-1) |
1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MA DN1855045) | |
Enumeration Date | 2006-09-20 |
Last Update Date | 2009-09-03 |