| NPI | 1538185376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 38348) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: CA 38348) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2009-11-20 |