| NPI | 1134381841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: CA 101997) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IN 12011577a) |
| 207L00000X Anesthesiology (Licence: CA 1870) | |
| Enumeration Date | 2008-06-25 |
| Last Update Date | 2019-05-15 |