| NPI | 1144393406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 42432) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ 4508) |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2022-11-02 |