NPI | 1073520789 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL DN12852) |
Additional Taxonomies | 122300000X Dentist (Licence: FL DN12852) |
Enumeration Date | 2006-08-02 |
Last Update Date | 2023-08-11 |