NPI | 1225322019 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 101077) |
Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 34607) |
204E00000X Oral & Maxillofacial Surgery (Licence: CA 157675) | |
204E00000X Oral & Maxillofacial Surgery (Licence: TX 34607) | |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2011-06-08 |
Last Update Date | 2019-10-31 |