NPI | 1679912711 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: MD LL870) |
Additional Taxonomies | 122300000X Dentist (Licence: MD LL870) |
1223P0106X Dentist Oral and Maxillofacial Pathology (Licence: MD LL870) | |
Enumeration Date | 2013-06-21 |
Last Update Date | 2020-08-16 |