NPI | 1952386609 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MA 15125) |
Additional Taxonomies | 122300000X Dentist (Licence: MA 15125) |
Enumeration Date | 2005-12-14 |
Last Update Date | 2014-10-28 |