| NPI | 1083195085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 103982) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 34568) |
| Enumeration Date | 2018-08-27 |
| Last Update Date | 2022-04-14 |