| NPI | 1871685164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 42098) |
| Additional Taxonomies | 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck (Licence: CA A64127) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: CA A64127) | |
| 2086S0127X Surgery, Trauma Surgery (Licence: CA A64127) | |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2009-09-15 |