| NPI | 1053450577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 55496) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ D7079) |
| 1223G0001X Dentist, General Practice (Licence: CA 55496) | |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2020-09-09 |