NPI | 1629053798 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: CA 48830) |
Additional Taxonomies | 122300000X Dentist (Licence: CA 48830) |
Enumeration Date | 2005-12-13 |
Last Update Date | 2018-10-25 |