| NPI | 1447771100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: CA 101476) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: CA 101476) |
| Enumeration Date | 2017-07-03 |
| Last Update Date | 2022-10-17 |