NPI | 1336370444 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 37601) |
Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: CA 37601) |
Enumeration Date | 2009-08-06 |
Last Update Date | 2018-03-17 |