NPI | 1538535901 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: TX 31272) |
Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 31272) |
1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 0401418153) | |
1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MD 17548) | |
Enumeration Date | 2015-08-19 |
Last Update Date | 2022-09-28 |