| NPI | 1740294412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA GA1358) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 23135) |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2011-10-13 |