NPI | 1306224266 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: DC DEN2000518) |
Additional Taxonomies | 122300000X Dentist (Licence: NC 11356) |
122300000X Dentist (Licence: VA 0401415370) | |
Enumeration Date | 2015-05-12 |
Last Update Date | 2025-07-11 |