NPI | 1871685164 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 42098) |
Additional Taxonomies | 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck (Licence: CA A64127) |
2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: CA A64127) | |
2086S0127X Surgery, Trauma Surgery (Licence: CA A64127) | |
Enumeration Date | 2006-09-28 |
Last Update Date | 2009-09-15 |