NPI | 1467611632 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CT 10946) |
Additional Taxonomies | 122300000X Dentist (Licence: CT 10946) |
Enumeration Date | 2008-06-03 |
Last Update Date | 2013-06-19 |