| NPI | 1053382374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: CA 59280) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: PA DS026519L) |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: PA 59280) | |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2019-04-25 |