| NPI | 1851418255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 51353) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1855469) |
| 122300000X Dentist (Licence: CA 51353) | |
| 122300000X Dentist (Licence: NY 054368-1) | |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2024-04-16 |