NPI | 1982755419 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: CA 41732) |
Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: CA A72043) |
Enumeration Date | 2007-01-12 |
Last Update Date | 2007-07-09 |