| NPI | 1720174832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: CA A90801) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 52203) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2016-06-28 |