NPI | 1407304959 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: AZ D011692) |
Additional Taxonomies | 122300000X Dentist (Licence: TX 32395) |
Enumeration Date | 2016-09-13 |
Last Update Date | 2023-05-05 |