| NPI | 1093372591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 102703) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA DN1858383) |
| Enumeration Date | 2019-05-21 |
| Last Update Date | 2020-12-24 |