| NPI | 1962561340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: CA 55172) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: CA A126291) |
| Enumeration Date | 2006-12-08 |
| Last Update Date | 2020-05-21 |