NPI | 1922257021 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: UT 7066379-9921) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 7066379-9921) |
Enumeration Date | 2008-09-12 |
Last Update Date | 2021-05-18 |