| 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 |