| NPI | 1770898702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA DDS102681) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 055799) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PA DS040134) | |
| Enumeration Date | 2010-08-14 |
| Last Update Date | 2019-09-25 |