| NPI | 1346403169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 53943) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: CA A115872) |
| Enumeration Date | 2008-07-02 |
| Last Update Date | 2011-10-20 |