| NPI | 1659465391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 45239) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NV 3520) |
| 1223G0001X Dentist, General Practice (Licence: CA 45239) | |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2020-10-13 |