| NPI | 1104079755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NV S2-122) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA CA61212) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 0401415752) | |
| Enumeration Date | 2008-10-28 |
| Last Update Date | 2022-07-21 |