NPI | 1346613312 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: MI 2901601967) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA DN1857103) |
1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MI 2901601967) | |
Enumeration Date | 2015-11-12 |
Last Update Date | 2023-11-14 |