| NPI | 1144323247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2010013408) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 54559) |
| Enumeration Date | 2006-09-06 |
| Last Update Date | 2020-06-03 |