| NPI | 1962519272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 37485) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: CA A055148) |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2021-04-23 |