| NPI | 1063795797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 60887) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 60887) |
| Enumeration Date | 2011-09-20 |
| Last Update Date | 2021-07-15 |