| NPI | 1134418304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 101264) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA 149022) |
| Enumeration Date | 2011-03-28 |
| Last Update Date | 2017-07-12 |