| NPI | 1881747434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: NV 9844) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: CA A69879) |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: CA 42074) | |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2019-04-11 |