| NPI | 1689100018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: CA 106269) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: TN 10926) |
| Enumeration Date | 2017-05-04 |
| Last Update Date | 2021-10-28 |