| NPI | 1245326826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 34516) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA G74099) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2026-01-16 |