| NPI | 1295098846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 63122) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2014011361) |
| Enumeration Date | 2012-06-19 |
| Last Update Date | 2021-07-22 |