| NPI | 1366064347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: CA 106311) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 106311) |
| Enumeration Date | 2020-05-12 |
| Last Update Date | 2022-04-04 |