| NPI | 1629205174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA A143794) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA A143794) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA OMS109) | |
| Enumeration Date | 2009-06-11 |
| Last Update Date | 2020-06-19 |