NPI | 1306258280 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MI 2901021215) |
Additional Taxonomies | 122300000X Dentist (Licence: MI 2901021215) |
Enumeration Date | 2014-05-27 |
Last Update Date | 2024-05-08 |