| NPI | 1194112060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: CA A165493) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA DDS65003) |
| Enumeration Date | 2015-04-18 |
| Last Update Date | 2025-01-28 |