| NPI | 1811056294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 57634) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: UT 6768219-9922) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NV 6025) | |
| Enumeration Date | 2006-12-08 |
| Last Update Date | 2011-07-22 |