NPI | 1942287081 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NC 12698) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MN d12162) |
1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MN D12162) | |
Enumeration Date | 2005-12-29 |
Last Update Date | 2023-03-07 |