NPI | 1770612780 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MI 014082) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 014082) |
Enumeration Date | 2007-03-05 |
Last Update Date | 2024-08-08 |