| NPI | 1851597991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CA A97977) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 50071) |
| Enumeration Date | 2007-06-25 |
| Last Update Date | 2016-05-06 |