NPI | 1700267408 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MI 2901601665) |
Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: WI 18375) |
1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 36093) | |
204E00000X Oral & Maxillofacial Surgery (Licence: MA DL13260) | |
Enumeration Date | 2015-06-18 |
Last Update Date | 2024-06-20 |