| NPI | 1174592372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: CA 55703) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: TX M0604) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MA 19775) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 22087) | |
| Enumeration Date | 2006-03-17 |
| Last Update Date | 2024-10-30 |