NPI | 1497817191 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 57031) |
Additional Taxonomies | 122300000X Dentist (Licence: NY 050824) |
Enumeration Date | 2006-12-16 |
Last Update Date | 2014-12-05 |