NPI | 1801060967 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL DN 17919) |
Additional Taxonomies | 122300000X Dentist (Licence: FL 17919) |
Enumeration Date | 2008-04-18 |
Last Update Date | 2015-09-28 |