NPI | 1962545947 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: MD D0066077) |
Additional Taxonomies | 2086S0127X Surgery, Trauma Surgery (Licence: MD D0066077) |
122300000X Dentist (Licence: MD 61 (Teaching)) | |
Enumeration Date | 2007-02-15 |
Last Update Date | 2008-02-20 |