| NPI | 1043642069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 62702) |
| Additional Taxonomies | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: CA 62702) |
| 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: PA DS045628) | |
| Enumeration Date | 2013-08-01 |
| Last Update Date | 2026-09-10 |