| NPI | 1083799316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: CA 57970) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: VA 0401411482) |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: CA 057970) | |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2016-11-02 |