NPI | 1821386285 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 65305) |
Additional Taxonomies | 122300000X Dentist (Licence: TN 9353) |
Enumeration Date | 2011-07-19 |
Last Update Date | 2022-09-01 |