| NPI | 1073734612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901018891) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 59216) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MI 2901018891) | |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: MI 4301093272) | |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2018-10-24 |