| NPI | 1841485620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: CA 55221) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 55221) |
| Enumeration Date | 2007-09-13 |
| Last Update Date | 2013-03-26 |