| NPI | 1952909087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 39012) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 105615) |
| Enumeration Date | 2020-10-12 |
| Last Update Date | 2024-02-19 |