| NPI | 1932206851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: CA G81937) |
| Additional Taxonomies | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: CA G81937) |
| 261QA1903X Clinic/Center Ambulatory Surgical (Licence: CA 10005) | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2011-10-06 |