NPI | 1538185376 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 38348) |
Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: CA 38348) |
Enumeration Date | 2006-07-14 |
Last Update Date | 2009-11-20 |