| NPI | 1639334212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 53917) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A115339) |
| Enumeration Date | 2008-07-23 |
| Last Update Date | 2011-08-09 |