NPI | 1114195344 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CT 009831) |
Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: CT 046141) |
Enumeration Date | 2008-02-11 |
Last Update Date | 2024-10-10 |