| NPI | 1679736425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: CA 50018) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: CA A97980) |
| Enumeration Date | 2008-07-02 |
| Last Update Date | 2009-06-17 |