| NPI | 1750367751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 41667) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA A67982) |
| Enumeration Date | 2005-12-21 |
| Last Update Date | 2014-08-26 |