| NPI | 1063491785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 52224) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PA DS028293L) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MD 11916) | |
| Enumeration Date | 2006-01-11 |
| Last Update Date | 2021-01-14 |