| NPI | 1063609030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: CA A102021) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 48850) |
| 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: CA A102021) | |
| Enumeration Date | 2007-10-03 |
| Last Update Date | 2008-08-27 |