| NPI | 1740387752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 29573) |
| Additional Taxonomies | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: CA 29573) |
| 1223X0008X Dentist, Oral and Maxillofacial Radiology (Licence: CA 29573) | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2011-04-01 |