| NPI | 1184989170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A19674) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 62270) |
| 122300000X Dentist (Licence: IA 08910) | |
| Enumeration Date | 2012-07-06 |
| Last Update Date | 2023-10-27 |