| NPI | 1760531644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: AZ D4371) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA OMS27) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: AZ 26402) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: CA A064888) | |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2007-07-08 |