| NPI | 1477081941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA A183091) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A183091) |
| Enumeration Date | 2017-05-30 |
| Last Update Date | 2023-06-11 |