NPI | 1700499068 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: AZ D011353) |
Additional Taxonomies | 122300000X Dentist (Licence: CA 105379) |
Enumeration Date | 2020-08-26 |
Last Update Date | 2024-05-03 |