| NPI | 1639493281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: NV S2-134C) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: UT 7670479-9921) |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: CA 63189) | |
| Enumeration Date | 2010-03-24 |
| Last Update Date | 2015-09-14 |