| NPI | 1700352903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 108610) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401416283) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 0401416283) | |
| Enumeration Date | 2018-10-16 |
| Last Update Date | 2023-11-21 |