NPI | 1972913382 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MI 4301505261) |
Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: MI 4301505261) |
Enumeration Date | 2014-05-07 |
Last Update Date | 2025-08-26 |