| NPI | 1336727221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 106529) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA NA) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 106529) | |
| Enumeration Date | 2021-03-31 |
| Last Update Date | 2022-10-11 |