| NPI | 1366413361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 59980) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CO 8404) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CO 8504) | |
| Enumeration Date | 2006-01-28 |
| Last Update Date | 2020-05-22 |