NPI | 1366058356 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MI 2952000720) |
Additional Taxonomies | 122300000X Dentist (Licence: MI 2952000720) |
Enumeration Date | 2020-09-16 |
Last Update Date | 2020-10-19 |