NPI | 1164624433 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: KY 8480) |
Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 62546) |
1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA A125274) | |
Enumeration Date | 2007-05-31 |
Last Update Date | 2013-08-28 |