| NPI | 1497750368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 56767) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NV 3708 S2-31) |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2017-04-05 |