| NPI | 1043317720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QS1201X Family Medicine, Sleep Medicine (Licence: CA 54255) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 23448) |
| 1223G0001X Dentist, General Practice (Licence: CA 54255) | |
| Enumeration Date | 2006-09-17 |
| Last Update Date | 2023-08-29 |