NPI | 1760043202 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MN D14275) |
Additional Taxonomies | 122300000X Dentist (Licence: MN D14275) |
Enumeration Date | 2019-06-25 |
Last Update Date | 2024-07-18 |