| NPI | 1962965889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 110754) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 061223) |
| 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: CA 110754) | |
| Enumeration Date | 2019-04-08 |
| Last Update Date | 2024-10-23 |