| NPI | 1033539606 |
|---|---|
| Former Name | ANDREI MENIAILENKO |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: CA A169364) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 30-024392) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: LA 6973) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: LA 6973) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: CA 104868) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: OH 30-024392) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-04-23 |
| Last Update Date | 2021-04-17 |