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 |