| NPI | 1528039138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 53522) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WA 5739) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: AZ 4881) | |
| Enumeration Date | 2006-01-31 |
| Last Update Date | 2013-09-11 |