| NPI | 1770808875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: CA 106820) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: NV S2-183C) |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: NE 6876) | |
| Enumeration Date | 2010-03-31 |
| Last Update Date | 2021-11-09 |