| NPI | 1699928820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: CA A120215) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 56691) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: CA 56691) | |
| Enumeration Date | 2008-10-31 |
| Last Update Date | 2023-05-08 |