| NPI | 1912246356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 62028) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 62028) |
| Enumeration Date | 2013-02-05 |
| Last Update Date | 2023-08-24 |