NPI | 1124450663 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TN 11183) |
Additional Taxonomies | 122300000X Dentist (Licence: NV 6444) |
Enumeration Date | 2013-08-07 |
Last Update Date | 2023-09-27 |