| NPI | 1891942652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 57537) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 052492) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 32570) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NV S2-150C) | |
| Enumeration Date | 2008-08-24 |
| Last Update Date | 2019-11-25 |