NPI | 1215076534 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 25869) |
Additional Taxonomies | 1223X2210X Dentist, Orofacial Pain (Licence: CA 25869) |
1223P0700X Dentist, Prosthodontics (Licence: CA 25869) | |
Enumeration Date | 2007-02-05 |
Last Update Date | 2024-04-18 |