NPI | 1689100018 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 106269) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TN 10926) |
Enumeration Date | 2017-05-04 |
Last Update Date | 2021-10-28 |