| NPI | 1659699627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA DDS100052) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: CA 142522) |
| Enumeration Date | 2010-05-14 |
| Last Update Date | 2019-01-15 |