| NPI | 1952394421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: CA 31638) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 31638) |
| Enumeration Date | 2005-08-30 |
| Last Update Date | 2009-01-23 |