| NPI | 1023443454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 62927) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 62927) |
| Enumeration Date | 2013-09-04 |
| Last Update Date | 2024-04-22 |