| NPI | 1104954999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: CA 52130) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 52130) |
| Enumeration Date | 2007-03-01 |
| Last Update Date | 2023-10-27 |