| NPI | 1497065775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: CA 59518) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: FL DN23517) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: FL DN23517) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: CA 59518) | |
| Enumeration Date | 2010-10-20 |
| Last Update Date | 2023-06-06 |