| NPI | 1184850315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CO 202724) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 62211) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: UT 8504184) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: AZ D008773) | |
| Enumeration Date | 2009-06-02 |
| Last Update Date | 2016-05-03 |