| NPI | 1710949979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: CA 58144) |
| Additional Taxonomies | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: WA DE60086482) |
| Enumeration Date | 2006-04-04 |
| Last Update Date | 2009-11-23 |