| NPI | 1609115336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 61913) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 61913) |
| Enumeration Date | 2013-01-31 |
| Last Update Date | 2021-06-10 |