NPI | 1992826333 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: VA 0101251217) |
Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 0401413454) |
Enumeration Date | 2007-04-03 |
Last Update Date | 2013-06-14 |