| NPI | 1073697348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA DDS48617) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 48617) |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2022-07-25 |