| NPI | 1942477930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 56712) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 56712) |
| 122300000X Dentist (Licence: TX 26280) | |
| Enumeration Date | 2008-05-09 |
| Last Update Date | 2024-05-22 |