| NPI | 1396997268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA A154724) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 100045) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: OR MD189700) | |
| Enumeration Date | 2008-10-22 |
| Last Update Date | 2020-09-11 |