NPI | 1770983355 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NC 00216) |
Additional Taxonomies | 122300000X Dentist (Licence: MA DN1857193) |
122300000X Dentist (Licence: ME DEN4397) | |
Enumeration Date | 2014-09-02 |
Last Update Date | 2020-07-20 |