NPI | 1023378999 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 35986) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 61852) |
Enumeration Date | 2012-05-24 |
Last Update Date | 2020-07-22 |