NPI | 1588189435 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: GA DNF000435) |
Additional Taxonomies | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: GA DNF000435) |
125Q00000X Oral Medicine (Licence: GA DNF000435) | |
Enumeration Date | 2017-08-11 |
Last Update Date | 2023-04-13 |