| NPI | 1083092001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 101926) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NV 6608) |
| Enumeration Date | 2015-05-11 |
| Last Update Date | 2021-02-09 |