NPI | 1982843850 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: CA 55516) |
Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 55516) |
204E00000X Oral & Maxillofacial Surgery (Licence: CA a113979) | |
Enumeration Date | 2009-02-17 |
Last Update Date | 2024-06-03 |