| NPI | 1336309285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 57035) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: CA 57035) |
| Enumeration Date | 2008-06-13 |
| Last Update Date | 2023-05-08 |