| NPI | 1740296151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA DDS42582) |
| Additional Taxonomies | 1223X2210X Dentist, Orofacial Pain (Licence: CA 42582) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2026-01-15 |