| NPI | 1801268883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 45242) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA DDS45242) |
| Enumeration Date | 2015-10-29 |
| Last Update Date | 2018-09-20 |