NPI | 1043697543 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL DRPM2328) |
Additional Taxonomies | 122300000X Dentist (Licence: WI 1001125-15) |
Enumeration Date | 2015-05-04 |
Last Update Date | 2021-06-11 |