| NPI | 1073023172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA DDS101641) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 101641) |
| Enumeration Date | 2017-10-03 |
| Last Update Date | 2022-05-27 |