| NPI | 1558093989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CA PTL22324) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA DDS108056) |
| 1223G0001X Dentist, General Practice (Licence: CA DDS108056) | |
| Enumeration Date | 2022-06-24 |
| Last Update Date | 2026-11-04 |