| NPI | 1174042287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 101889) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 059999) |
| 1223G0001X Dentist, General Practice (Licence: AZ D011266) | |
| Enumeration Date | 2017-09-11 |
| Last Update Date | 2022-03-28 |