| NPI | 1205948270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X (Licence: CA ds36308) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA ds36308) |
| 1223X2210X Dentist, Orofacial Pain (Licence: CA ds36308) | |
| 174400000X Specialist (Licence: CA 36308) | |
| 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: CA 36308) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2022-07-07 |