| NPI | 1336370444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: CA 37601) |
| Additional Taxonomies | 1223P0300X Dentist Periodontics (Licence: CA 37601) |
| Enumeration Date | 2009-08-06 |
| Last Update Date | 2018-03-17 |