NPI | 1730420910 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MN 13948) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WI 7101) |
1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MN D13948) | |
Enumeration Date | 2013-03-12 |
Last Update Date | 2023-04-27 |