| NPI | 1033401203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA CA65189) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA CA65189) |
| Enumeration Date | 2011-05-06 |
| Last Update Date | 2019-12-16 |