| NPI | 1487980819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 54007) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: CA A113863) |
| Enumeration Date | 2009-10-20 |
| Last Update Date | 2012-06-29 |