| NPI | 1649649831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA DDS100673) |
| Additional Taxonomies | 122300000X Dentist (Licence: OR D10350) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 100673) | |
| Enumeration Date | 2015-09-18 |
| Last Update Date | 2021-08-24 |