| NPI | 1164736070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D008691) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 2010023227) |
| Enumeration Date | 2010-08-03 |
| Last Update Date | 2020-12-29 |