NPI | 1952753964 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CT 13740) |
Additional Taxonomies | 208600000X Surgery (Licence: CT 75128) |
Enumeration Date | 2016-07-01 |
Last Update Date | 2025-05-16 |