NPI | 1447547427 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MD 17649) |
Additional Taxonomies | 122300000X Dentist (Licence: MD 17649) |
208600000X Surgery (Licence: PA MT-199807) | |
Enumeration Date | 2011-06-29 |
Last Update Date | 2022-01-05 |