NPI | 1689295008 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: CA DDS105202) |
Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA DDS105202) |
208600000X Surgery (Licence: CA PTL14402) | |
Enumeration Date | 2020-04-27 |
Last Update Date | 2025-04-30 |