| NPI | 1497455224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 109540) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA 21844) |
| 122300000X Dentist (Licence: CA 109540) | |
| Enumeration Date | 2023-03-09 |
| Last Update Date | 2026-09-18 |