| NPI | 1962508549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 19101) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 19101) |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2010-04-05 |