| NPI | 1336271170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: NV S2-156C) |
| Additional Taxonomies | 1223P0106X Dentist Oral and Maxillofacial Pathology (Licence: CA DDS43902) |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2018-08-23 |