| NPI | 1932371184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: CA 100527) |
| Additional Taxonomies | 1223D0004X Dentist Dentist Anesthesiologist (Licence: CA CS1172) |
| 1223G0001X Dentist General Practice (Licence: CA 100527) | |
| 1223G0001X Dentist General Practice (Licence: NV 5543) | |
| Enumeration Date | 2008-03-27 |
| Last Update Date | 2020-09-09 |