NPI | 1043657364 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: ID D-5107-OS) |
Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: ID m-15171) |
1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WA DE60941667) | |
Enumeration Date | 2013-05-28 |
Last Update Date | 2022-03-01 |