NPI | 1982071478 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MN D13963) |
Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: MN R639) |
204E00000X Oral & Maxillofacial Surgery (Licence: MN 72000) | |
Enumeration Date | 2015-08-31 |
Last Update Date | 2022-08-12 |