| NPI | 1215066329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: CA 50117) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 50117) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: CA A104572) | |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2011-01-18 |