| NPI | 1902132244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: CA 107193) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 059354) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 107193) | |
| 174400000X Specialist (Licence: NY 059354) | |
| 174400000X Specialist (Licence: CA 107193) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: NY 059354) | |
| Enumeration Date | 2009-10-21 |
| Last Update Date | 2021-12-16 |