NPI | 1306299565 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 0438000494) |
Additional Taxonomies | 122300000X Dentist (Licence: AL 6338) |
1223G0001X Dentist, General Practice (Licence: VA 0401418669) | |
Enumeration Date | 2016-07-22 |
Last Update Date | 2025-06-04 |