NPI | 1720373897 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CO 00203015) |
Additional Taxonomies | 122300000X Dentist (Licence: CA 60429) |
Enumeration Date | 2011-06-16 |
Last Update Date | 2022-07-21 |