| NPI | 1164587796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 8017575-9922) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 30711) |
| Enumeration Date | 2006-12-26 |
| Last Update Date | 2021-11-24 |