| NPI | 1114121720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OR D9280) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: AZ D7213) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 48706) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: CA A94009) | |
| Enumeration Date | 2007-06-14 |
| Last Update Date | 2012-07-23 |