NPI | 1770743387 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: CO DEN.00202539) |
Additional Taxonomies | 122300000X Dentist (Licence: PA DS-037905) |
122300000X Dentist (Licence: NE 6755) | |
208600000X Surgery (Licence: CO DR.0055864) | |
Enumeration Date | 2008-06-17 |
Last Update Date | 2022-09-09 |