NPI | 1871048157 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL DN21973) |
Additional Taxonomies | 122300000X Dentist (Licence: FL DN 21973) |
Enumeration Date | 2016-08-17 |
Last Update Date | 2021-07-03 |