| NPI | 1992860506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 22146) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: CA G66802) |
| Enumeration Date | 2006-12-26 |
| Last Update Date | 2007-07-08 |