NPI | 1194976332 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: LA 6918) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: ID D-4177) |
1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CO DEN.00205712) | |
Enumeration Date | 2008-10-07 |
Last Update Date | 2023-09-26 |