NPI | 1578098398 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: UT 10358521-9922) |
Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NV S2-198C) |
Enumeration Date | 2017-04-30 |
Last Update Date | 2024-04-21 |