| NPI | 1093951352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WY WY1265) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 57754) |
| Enumeration Date | 2008-12-16 |
| Last Update Date | 2015-12-07 |