| NPI | 1477799492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 54765) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 54765) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: CA A113874) | |
| 208600000X Surgery (Licence: CA A113874) | |
| Enumeration Date | 2008-12-22 |
| Last Update Date | 2017-02-02 |