| NPI | 1710211222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery (Licence: CO DEN.00205128) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 58760) |
| Enumeration Date | 2009-09-30 |
| Last Update Date | 2023-07-05 |