NPI | 1255482527 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 49312) |
Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: CA A94751) |
Enumeration Date | 2007-01-15 |
Last Update Date | 2007-07-08 |