| NPI | 1083387385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CA 106570) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 106570) |
| 1223G0001X Dentist General Practice (Licence: CA DDS106580) | |
| Enumeration Date | 2021-08-01 |
| Last Update Date | 2023-02-21 |