NPI | 1922623834 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: TX 38912) |
Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MN R760) |
Enumeration Date | 2020-06-16 |
Last Update Date | 2025-04-21 |