NPI | 1891122172 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 62866) |
Additional Taxonomies | 122300000X Dentist (Licence: CA 62866) |
Enumeration Date | 2013-10-02 |
Last Update Date | 2024-02-22 |