| NPI | 1033536800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 26245) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 26245) |
| Enumeration Date | 2014-03-18 |
| Last Update Date | 2021-02-18 |