NPI | 1861605487 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: OR MD28928) |
Additional Taxonomies | 122300000X Dentist (Licence: TX 21510) |
Enumeration Date | 2007-05-08 |
Last Update Date | 2009-06-02 |