| NPI | 1700499068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: AZ D011353) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 105379) |
| Enumeration Date | 2020-08-26 |
| Last Update Date | 2024-05-03 |