| NPI | 1962530550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA BJ8023119) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 50275) |
| 122300000X Dentist (Licence: CA BJ8023119) | |
| Enumeration Date | 2007-03-02 |
| Last Update Date | 2024-09-26 |