NPI | 1831509645 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: MN 64379) |
Additional Taxonomies | 122300000X Dentist (Licence: MN D13381) |
1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MN D13381) | |
204E00000X Oral & Maxillofacial Surgery (Licence: MN D13381) | |
Enumeration Date | 2014-05-01 |
Last Update Date | 2020-07-27 |