| NPI | 1215177324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: DC DEN5646) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 51204) |
| Enumeration Date | 2009-03-02 |
| Last Update Date | 2017-12-29 |