| NPI | 1881887727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 37762) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: CA 37762) |
| Enumeration Date | 2007-08-23 |
| Last Update Date | 2024-04-27 |