| 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 |