| NPI | 1235216185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: CA A92044) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: CA OMS 89) |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: OK OMFS SPECIALTY 157) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: AZ 41157) | |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2023-10-13 |