| NPI | 1073871448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: CA OMS106) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: MA DN1856460) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: CA A127360) | |
| Enumeration Date | 2012-04-24 |
| Last Update Date | 2022-05-05 |