NPI | 1053752642 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MS 3715-13) |
Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MS OS-527-17) |
Enumeration Date | 2013-07-11 |
Last Update Date | 2020-07-21 |