| NPI | 1588896740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NV S2-141C) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 58517) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: CA 127414) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 58517) | |
| Enumeration Date | 2009-08-20 |
| Last Update Date | 2016-06-15 |