NPI | 1164954582 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 125Q00000X Oral Medicine (Licence: VA 0401417624) |
Additional Taxonomies | 122300000X Dentist (Licence: VA 0401417624) |
Enumeration Date | 2017-04-03 |
Last Update Date | 2023-03-09 |