| NPI | 1881779387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA C5939675) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: CA C5939675) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2007-07-08 |