| NPI | 1669691200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: CA 48487) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: AL 30138) |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: FL DN17902) | |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: AL 5224) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: CA A128233) | |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2015-02-11 |