| NPI | 1891215760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 104972) |
| Additional Taxonomies | 1223X0008X Dentist, Oral and Maxillofacial Radiology (Licence: CA 104972) |
| 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: CA 104972) | |
| 1223P0300X Dentist, Periodontics (Licence: CA 104972) | |
| 1223G0001X Dentist, General Practice (Licence: CA 104972) | |
| 1223X2210X Dentist, Orofacial Pain (Licence: CA 104972) | |
| 1223E0200X Dentist, Endodontics (Licence: CA 104972) | |
| 1223P0700X Dentist, Prosthodontics (Licence: CA 104972) | |
| 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: CA 104972) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 104972) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 104972) | |
| Enumeration Date | 2017-06-22 |
| Last Update Date | 2026-03-06 |