NPI | 1700848827 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: SC 4453 772 os) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TN 7629) |
Enumeration Date | 2006-04-04 |
Last Update Date | 2013-02-12 |