| NPI | 1154645661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL DN28761) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 7764010-9921-2014040) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA DDS107230) | |
| Enumeration Date | 2010-03-26 |
| Last Update Date | 2024-01-19 |