| NPI | 1396796793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: GA DNF000323) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 052730) |
| 122300000X Dentist (Licence: CA 46235) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: NY 052730) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: CA 46235) | |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2007-07-08 |