NPI | 1225487622 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: CA 65087) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 65087) |
1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 65087) | |
Enumeration Date | 2016-06-07 |
Last Update Date | 2018-12-18 |