NPI | 1689980237 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MD 18345) |
Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 35760) |
1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: UT 7747079-9921) | |
Enumeration Date | 2010-08-20 |
Last Update Date | 2024-08-26 |