| NPI | 1740339233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 24282) |
| Additional Taxonomies | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: CA 24282) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 24282) | |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2011-12-05 |