NPI | 1902474760 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: NE 10072) |
Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NE 7731) |
122300000X Dentist (Licence: MI 2901600937) | |
Enumeration Date | 2021-06-16 |
Last Update Date | 2024-06-28 |