| NPI | 1023365442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 62280) |
| Additional Taxonomies | 122300000X Dentist (Licence: NE 7047) |
| Enumeration Date | 2012-08-06 |
| Last Update Date | 2021-10-19 |