| NPI | 1215076534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: CA 25869) |
| Additional Taxonomies | 1223X2210X Dentist Orofacial Pain (Licence: CA 25869) |
| 1223P0700X Dentist Prosthodontics (Licence: CA 25869) | |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2024-04-18 |