NPI | 1790086957 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: OR D11405) |
Additional Taxonomies | 122300000X Dentist (Licence: AK 1364) |
Enumeration Date | 2010-11-04 |
Last Update Date | 2021-04-02 |