| NPI | 1326214941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA OMS102) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: NY 60 257968) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 50 053256) | |
| 208600000X Surgery (Licence: CA A124593) | |
| Enumeration Date | 2008-05-03 |
| Last Update Date | 2014-11-06 |