| NPI | 1750700837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: VA 0401416451) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: CA 63526) |
| 171000000X Military Health Care Provider | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: CA 63526) | |
| Enumeration Date | 2014-04-16 |
| Last Update Date | 2022-03-24 |