| NPI | 1922128321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 73) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: LA 5440) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: PA MD428786) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: CA A98904) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: LA MD200551) | |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2008-03-06 |