| NPI | 1558579144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: CA A107428) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 50017) |
| 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: CA 50017) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 50017) | |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: CA A107428) | |
| 2086S0127X Surgery, Trauma Surgery (Licence: CA A107428) | |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2023-03-07 |