| NPI | 1073914545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 103264) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA DN1856726) |
| 122300000X Dentist (Licence: MA DN1856726) | |
| 1223G0001X Dentist, General Practice (Licence: CA 103264) | |
| Enumeration Date | 2014-09-15 |
| Last Update Date | 2023-02-03 |