| NPI | 1861786634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CO DEN.00204110) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 100364) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MO 2015009435) | |
| Enumeration Date | 2011-06-08 |
| Last Update Date | 2024-08-05 |