| NPI | 1013390780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 109157) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IN 12012370A) |
| Enumeration Date | 2015-06-30 |
| Last Update Date | 2023-09-01 |