| NPI | 1992767735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: CA OMS30) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: CA A71622) |
| Enumeration Date | 2006-04-05 |
| Last Update Date | 2007-07-08 |