| NPI | 1053417261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: CA 52875) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 52875) |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2016-08-04 |