NPI | 1508347717 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MA DN1858160) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA DN1858160) |
Enumeration Date | 2018-08-25 |
Last Update Date | 2019-10-07 |