| NPI | 1053489088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 0438000234) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA OMS49) |
| 122300000X Dentist (Licence: PA DS030776L) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: CA OMS49) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 0401411829) | |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2007-10-05 |