| NPI | 1003121880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 108873) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 25869) |
| 1223G0001X Dentist, General Practice (Licence: CA 59448) | |
| Enumeration Date | 2010-08-17 |
| Last Update Date | 2023-09-01 |