NPI | 1902132244 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: CA 107193) |
Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 059354) |
1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 107193) | |
174400000X Specialist (Licence: NY 059354) | |
174400000X Specialist (Licence: CA 107193) | |
204E00000X Oral & Maxillofacial Surgery (Licence: NY 059354) | |
Enumeration Date | 2009-10-21 |
Last Update Date | 2021-12-16 |