NPI | 1740893791 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: SC 10327) |
Additional Taxonomies | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: PA DS042900) |
Enumeration Date | 2020-08-28 |
Last Update Date | 2022-11-11 |