| NPI | 1265726897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA DDS101214) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 30090) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: UT 9811800-9921) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA A151709) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WA DENT.DE.60660678) | |
| Enumeration Date | 2011-05-31 |
| Last Update Date | 2019-04-16 |