| NPI | 1801125794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 60272) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 22401) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WA DE60115059) | |
| Enumeration Date | 2009-12-24 |
| Last Update Date | 2013-09-09 |