NPI | 1972609667 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CO 8192) |
Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: CO 38691) |
Enumeration Date | 2006-09-16 |
Last Update Date | 2007-07-08 |