| NPI | 1013258441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: CA A153496) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: KY 9362) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA OMS120) | |
| Enumeration Date | 2013-03-11 |
| Last Update Date | 2022-06-08 |