NPI | 1225419591 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IA 09188) |
Additional Taxonomies | 122300000X Dentist (Licence: IA 09188) |
Enumeration Date | 2015-06-12 |
Last Update Date | 2021-11-03 |