| NPI | 1164855763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA DDS62798) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 62798) |
| Enumeration Date | 2013-08-19 |
| Last Update Date | 2019-04-11 |