NPI | 1902825003 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: KY 7458) |
Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: KY 7458) |
Enumeration Date | 2006-07-19 |
Last Update Date | 2016-02-08 |