| NPI | 1033257233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 56613) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA de00010771) |
| 1223G0001X Dentist, General Practice (Licence: NV 4956T) | |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2021-06-10 |