| NPI | 1053584771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MA DN1855054) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 204E00000X Oral & Maxillofacial Surgery (Licence: CA A126769) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 57260) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: MA 262350) | |
| Enumeration Date | 2008-04-03 |
| Last Update Date | 2016-03-16 |