NPI | 1356908891 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 35666) |
Additional Taxonomies | 122300000X Dentist (Licence: TX 35666) |
Enumeration Date | 2019-05-21 |
Last Update Date | 2025-06-09 |