NPI | 1881893717 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: CT 052166) |
Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CT 010169) |
Enumeration Date | 2007-07-11 |
Last Update Date | 2014-01-14 |