| NPI | 1558416065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 28822) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: CA A50488) |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2013-12-11 |