| NPI | 1275822884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: CA 60253) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: CA A135913) |
| Enumeration Date | 2011-04-04 |
| Last Update Date | 2018-08-22 |