| NPI | 1013147438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 103712) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401412484) |
| 122300000X Dentist (Licence: DC DEN1000822) | |
| Enumeration Date | 2009-07-20 |
| Last Update Date | 2020-08-18 |