| NPI | 1649213174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 46419) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: CA A89128) |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2015-02-23 |