| NPI | 1740387422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA A 55473) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MA 17716) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA OMS 20) | |
| Enumeration Date | 2006-09-17 |
| Last Update Date | 2007-07-08 |