| NPI | 1689202236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 105317) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: CA 105317) |
| Enumeration Date | 2020-03-30 |
| Last Update Date | 2026-03-18 |