| NPI | 1912429101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NV S2-203C) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 101135) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 101135) | |
| Enumeration Date | 2017-07-10 |
| Last Update Date | 2023-05-31 |