NPI | 1962459636 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL dn14889) |
Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: CO DR.0075408) |
204E00000X Oral & Maxillofacial Surgery (Licence: MO 015430) | |
Enumeration Date | 2006-05-28 |
Last Update Date | 2025-06-04 |