| NPI | 1083182711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 108618) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OR D10923) |
| Enumeration Date | 2018-11-12 |
| Last Update Date | 2023-06-19 |